Cytomegalovirus-associated hemophagocytic lymphohistiocytosis in a patient with myasthenia gravis treated with azathioprine.
نویسندگان
چکیده
A 47-year-old woman with myasthenia gravis treated with azathioprine, prednisone, and plasmapheresis was admitted for respiratory failure following 2 weeks of fever with splenomegaly, jaundice, coagulopathy, and pancytopenia (white blood cells, 1.1 3 10/L with 64% neutrophils; hemoglobin, 9.5 g/dL; platelets, 79 3 10/L) but no substantial schistocytosis. Triglyceride (330 mg/dL) and ferritin (7562 ng/mL) levels were elevated; fibrinogen level was decreased (52 mg/dL). Soluble CD25 level was markedly elevated (17 092 U/mL), and natural killer cell activity was absent. Plasma was positive for cytomegalovirus (CMV) DNA. Bone marrow examination revealed prominent histiocytic hyperplasia with numerous hemophagocytes (panels A-C). Rare large cells with CMV cytopathic effects (panel D) were also present (confirmed by immunohistochemical staining; panel E). A diagnosis of hemophagocytic lymphohistiocytosis (HLH) accompanied by CMV infection was rendered.
منابع مشابه
MYASTHENIA GRAVIS AND THYMECTOMY: A 10-YEAR STUDY IN SHIRAZ
A retrospective comparative study was performed on 54 patients treated medically or surgically (thymectomy) for myasthenia gravis (MG) from 1979- 1989 in three Shiraz University Hospitals. Each surgical patient was compared with a medical patient on the basis of age, sex, severity and duration of disease. Complete remission was noted in 3 out of 27 thymectomized patients but in none of the...
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ورودعنوان ژورنال:
- Blood
دوره 123 15 شماره
صفحات -
تاریخ انتشار 2014